Harvey's Garden

Diabetic gastroparesis

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Diabetic gastroparesis is a complication of long-term diabetes characterized by delayed gastric emptying that is not associated with mechanical obstruction.

Epidemiology

Etiology

Pathophysiology

  • Poor glycemic control, sustained hyperglycemia > 200 mg/dL → neuronal damage → impaired neural control of gastric function (e.g., interstitial cells of Cajal dysfunction, abnormal myenteric neurotransmission, smooth muscle dysfunction, vagal dysfunction) → antral motor coordination and function abnormalities (↓ antral contractions, pyloric spasms, abnormal antroduodenal contractions) → delayed gastric emptying

Clinical features

  • Common symptoms
    • Nausea and/or vomiting
    • Bloating
    • Upper abdominal pain
    • Loss of appetite
    • Early satiety
  • Examination findings
    • Abdominal distension
    • Epigastric tenderness
    • Succussion splash
  • Complications
    • Bezoars: Solid mass of indigestible material accumulating in the stomach. t

Diagnostics

Treatment

  • Lifestyle: Small/frequent meals, low fiber, low fat. Strict glucose control.
  • Metoclopramide (First-line)
    • MOA: D2 receptor antagonist; ↑ resting tone, contractility, and LES tone.
    • Adverse Effects: Extrapyramidal symptoms (parkinsonian features), Tardive Dyskinesia (irreversible; boxed warning), QT prolongation, hyperprolactinemia.
  • Erythromycin t
    • MOA: Motilin receptor agonist; stimulates high-amplitude gastric contractions.
    • Use: Typically for acute exacerbations (IV) or short-term use.
    • Limitation: Tachyphylaxis (tolerance) develops rapidly (usually <4 weeks).
  • Antiemetics: Used for symptomatic relief of nausea (e.g., Ondansetron, Promethazine).
  • Refractory: Gastric electrical stimulation.

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